---
type: claim
domain: health
description: "Income level correlates with GLP-1 discontinuation rates in commercially insured populations, indicating that cost-sharing and affordability barriers drive adherence as much as clinical factors like side effects or insufficient weight loss"
confidence: experimental
source: "Journal of Managed Care & Specialty Pharmacy, Real-world Persistence and Adherence to GLP-1 RAs Among Obese Commercially Insured Adults Without Diabetes, 2024-08-01"
created: 2026-03-11
related_claims:
  - divergence-glp1-economics-chronic-cost-vs-low-persistence
related:
- federal-budget-scoring-methodology-systematically-undervalues-preventive-interventions-because-10-year-window-excludes-long-term-savings
- glp-1-multi-organ-protection-creates-compounding-value-across-kidney-cardiovascular-and-metabolic-endpoints
- pcsk9-inhibitors-achieved-only-1-to-2-5-percent-penetration-despite-proven-efficacy-demonstrating-access-mediated-pharmacological-ceiling
- GLP-1 cost evidence accelerates value-based care adoption by proving that prevention-first interventions generate net savings under capitation within 24 months
- Is the GLP-1 economic problem unsustainable chronic costs or wasted investment from low persistence?
reweave_edges:
- federal-budget-scoring-methodology-systematically-undervalues-preventive-interventions-because-10-year-window-excludes-long-term-savings|related|2026-03-31
- glp-1-multi-organ-protection-creates-compounding-value-across-kidney-cardiovascular-and-metabolic-endpoints|related|2026-03-31
- pcsk9-inhibitors-achieved-only-1-to-2-5-percent-penetration-despite-proven-efficacy-demonstrating-access-mediated-pharmacological-ceiling|related|2026-03-31
- GLP-1 cost evidence accelerates value-based care adoption by proving that prevention-first interventions generate net savings under capitation within 24 months|related|2026-04-04
- GLP-1 access structure is inverted relative to clinical need because populations with highest obesity prevalence and cardiometabolic risk face the highest barriers creating an equity paradox where the most effective cardiovascular intervention will disproportionately benefit already-advantaged populations|supports|2026-04-04
- GLP-1 access follows systematic inversion where states with highest obesity prevalence have both lowest Medicaid coverage rates and highest income-relative out-of-pocket costs|supports|2026-04-14
- Is the GLP-1 economic problem unsustainable chronic costs or wasted investment from low persistence?|related|2026-04-17
supports:
- GLP-1 access structure is inverted relative to clinical need because populations with highest obesity prevalence and cardiometabolic risk face the highest barriers creating an equity paradox where the most effective cardiovascular intervention will disproportionately benefit already-advantaged populations
- GLP-1 access follows systematic inversion where states with highest obesity prevalence have both lowest Medicaid coverage rates and highest income-relative out-of-pocket costs
sourced_from:
- inbox/archive/health/2024-08-01-jmcp-glp1-persistence-adherence-commercial-populations.md
---

# Lower-income patients show higher GLP-1 discontinuation rates suggesting affordability not just clinical factors drive persistence

Among the factors associated with GLP-1 discontinuation in commercially insured populations, income level emerges as a significant predictor: lower-income patients show higher discontinuation rates even when controlling for other factors.

This is notable because the study population is commercially insured—meaning all patients have coverage. The income effect suggests that cost-sharing (copays, deductibles) creates an affordability barrier even within insured populations. For Medicare populations with higher cost-sharing and lower average incomes, this barrier may be substantially worse.

The implication for value-based care design: reducing patient cost-sharing for GLP-1s (through zero-copay programs or coverage carve-outs) may improve persistence enough to make the downstream ROI positive. The relevant question is not "does the drug work?" but "can patients afford to stay on it long enough for it to work?"

## Evidence

**Key discontinuation factors identified:**
- Insufficient weight loss (clinical disappointment)
- **Income level (lower income → higher discontinuation)**
- Adverse events (GI side effects)
- Insurance coverage changes

The source notes income as a factor but does not provide the specific discontinuation rate by income quartile. This limits the strength of the claim to experimental confidence.

**Context:**
- Study population: commercially insured adults (younger, higher income than Medicare)
- Even within this relatively advantaged population, income predicts discontinuation
- Medicare populations face higher cost-sharing (Part D coverage gap, higher average out-of-pocket costs)

**Mechanism hypothesis:**
At $245/month list price, even modest copays ($50-100/month) create a sustained affordability barrier. Patients may initiate treatment but discontinue when the monthly cost becomes unsustainable relative to household budget.

## Challenges

The source does not provide granular income-stratified discontinuation rates, so the magnitude of the effect is unclear. It's possible income is a proxy for other factors (health literacy, access to care coordination, baseline health status) rather than affordability per se.


### Additional Evidence (confirm)
*Source: 2025-11-06-trump-novo-lilly-glp1-price-deals-medicare | Added: 2026-03-16*

The Trump Administration deal establishes a $50/month out-of-pocket maximum for Medicare beneficiaries, explicitly targeting affordability as a persistence barrier. The $245/month Medicare price (down from ~$1,350) combined with the OOP cap is designed to address the affordability-driven discontinuation pattern observed in lower-income populations.


### Additional Evidence (confirm)
*Source: 2026-01-13-aon-glp1-employer-cost-savings-cancer-reduction | Added: 2026-03-18*

Aon's commercial claims data (employer-sponsored insurance) shows strong adherence effects, but the sample is biased toward higher-income employed populations. The fact that even in this relatively advantaged cohort, adherence is the key determinant of cost-effectiveness supports the claim that affordability barriers in lower-income populations would be even more binding.


### Additional Evidence (extend)
*Source: 2026-03-20-stat-glp1-semaglutide-india-patent-expiry-generics | Added: 2026-03-20*

OBBBA work requirements threaten to remove ~10M from Medicaid coverage precisely when international GLP-1 prices are dropping 50-90% but US prices remain patent-protected at $1,300/month through 2033. This creates structural access failure where coverage loss and price compression move in opposite directions for the population with highest metabolic disease burden.

---

### Additional Evidence (extend)
*Source: [[2026-03-29-circulation-cvqo-pcsk9-utilization-2015-2021]] | Added: 2026-03-29*

PCSK9 inhibitors show sociodemographic disparities in utilization independent of clinical indication. JAHA 2021 adoption study found Black and Hispanic ASCVD patients had lower PCSK9 utilization than white patients at all income levels. This pattern parallels GLP-1 discontinuation disparities, suggesting affordability/access barriers create systematic underutilization in lower-income and minority populations across multiple high-cost cardiovascular/metabolic drug classes.


Relevant Notes:
- [[GLP-1 receptor agonists are the largest therapeutic category launch in pharmaceutical history but their chronic use model makes the net cost impact inflationary through 2035]]
- [[value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk]]
- [[SDOH interventions show strong ROI but adoption stalls because Z-code documentation remains below 3 percent and no operational infrastructure connects screening to action]]

Topics:
- domains/health/_map